GI: Cholestasis

Question 1

What is cholestasis?

Answer 1

An impairment of bile formation and/or bile flow, which may clinically present with fatigue, pruritus, dark urine, pale stools and in its most overt form, jaundice and signs of fat soluble vitamin deficiences.

Question 2

Whatr are the two licensed drugs for cholestatic pruritus?

Answer 2

Colestryramine - 1st choice

Ursodeoxycholic acid - small and variable impact on cholestatic pruritus.

Question 3

What are the three unlicensed drugs for cholestatic pruritus?

Answer 3

Rifampicin
Sertraline
Naltrexone hydrochloride

Question 4

What is the drug of choice in treating cholestatic pruritus?

Answer 4

Colestyramine.

Question 5

What is colestyramine?

Answer 5

Drug of choice in treating cholestatic pruritis. It is an anion-exchange resin that is not absorbed from the gastro-intestinal tract.

It relieves pruritus by forming an insoluble complex in the intestine with bile acids and other compounds - the reduction of serum bile acid levels reduces excess deposition in the dermal tissue with a resultant decrease in pruritis,

Question 6

How does colestyramine relieve pruritus?

Answer 6

By forming an insoluble complex in the intestine with bile acids and other compounds - the reduction of serum bile acid levels reduces excess deposition in the dermal tissue with a resultant decrease in pruritus.

Question 7

Apart from treating cholestatic pruritis, what are the uses of colestyramine?

Answer 7

Hyperlipidaemias.

Primary prevention of coronary heart disease in men aged 35-59 years with primary hypercholesterolaemia who have not responded to diet and other appropriate measures.

Diarrhoea associated with Crohn’s disease, ileal resection, vagotomy, diabetic vagal neuropathy and radiation.

Accelerated elimination of teriflunomide.

Accelerated elmination of leflunomide (washout procedure).

Question 8

What agent is effective for the treatment of pruritus associated with intrahepatic cholestasis in pregnancy?

Answer 8

Ursodeoxycholic acid